Cosaldon has been fairly widely used on the Continent in the treatment of dementia and toxic confusional states. Meyer (1957), Leube (1959), Sperling (1960), Schmidt (1960), and Donati (1960) consider the drug to be of particular value in the treatment of arteriosclerotic dementia, and stress that the earlier the treatment is commenced the more favourable is the response.

Though there have been many studies on the pharmacological approach to depressive illness, opinions as to the indications for anti-depressant medication and the most appropriate substance to prescribe remain far from any state of general agreement.

E.C.T. is rightly regarded as a highly safe procedure and, although several thousands of treatments are given annually at this hospital, the occurrence of any serious complication is extremely rare.

Although much effort has gone into the description and classification of schizophrenic behaviour patterns, little attempt has been made to detail the course of the disorder. The present paper is an effort to trace the effects of chronicity on perception by use of a cross-sectional method. The specific tasks were selected to maximize autochthonous factors in perception. At the same time a demonstrable sensitivity to emotional states was desired, since changes in the schizophrenic condition are often considered reflections of reaction to stress. A wide enough area of behaviour was encompassed so that a general pattern, if one emerged, could be considered typical of perception as a whole.

A comparison of imipramine and electroplexy in 31 depressed patients selected for the latter treatment has already been reported (Robin and Harris, 1962). The following study concerns depressed patients chosen for conservative measures.

It became apparent soon after the introduction of chlorpromazine and reserpine that these drugs were capable both of influencing psychoses and of producing neurological disturbances closely resembling those seen in post-encephalitic Parkinsonism. In classifying drugs with these effects as “neuroleptics” Delay et al. (2) indicated that they considered the two actions to be inseparable thus implying that both resulted from common or closely related neurophysiological changes. On this basis it seemed likely that drugs which more readily produced these neurological disturbances would prove more effective in psychotic illness. It also seemed possible that there might be therapeutic value in the deliberate provocation of such disturbances, as was first advocated by Fleugel (6). The theoretical issues involved were referred to in a previous paper (MacLeod and Moffat (8)).

Extra-pyramidal reactions following on the administration of the major tranquillizers have been frequently reported on (May and Voegele, 1956; Druckman, Seelinger and Thulin, 1962; Freyhan, 1957).

The diagnostic classificatory system in use in modern psychiatry appears to be the product of countless acts of “subjective factor analysis”. Psychiatrists have observed that particular symptoms tend to occur in clusters, and these clusters have been labelled and given a status akin to that of disease entities in general medicine. It is a continually developing empirical system, and it is customary to reexamine such systems periodically to assess the state of current practice and its validity.

In studies of the incidence and prognosis of disease in the elderly it is valuable to have an objective measure of the patient's mental state. In a previous paper (Isaacs, 1962) a paired-associate verbal learning test devised by Inglis (1959) was applied to a group of 50 normal and 100 hospitalized old people, and was found to give useful information on the relationship between test performance and such factors as incontinence of urine and prognosis for rehabilitation. In the present study a simplified version of this test was performed on a larger number of elderly hospital patients. The test proved valuable in determining the characteristics of patients with varying degrees of mental impairment.

The literature contains only a few reports on plasma 17-hydroxycorticosteroids (17-OHCS) in mental patients (Bliss, Migeon, Branch and Samuels, 1955; Freeman, Steed, Hoegemeier, Wheeler, Savage and Wadeson, 1956; Board, Wadeson and Persky, 1957; Hoagland and Freeman, 1959). According to these investigators the mean values in schizophrenic patients do not differ significantly from values found in normal subjects.

Early in our clinical studies with the phrenotropic drugs, reserpine and chlorpromazine, we observed that psychotic patients receiving them were more resistant to treat for infectious processes that occurred during their hospitalization (Saunders, 1961). We also observed that in experimental animals, the LD50 of a standardized dose of bacteria was significantly increased if the rats had been previously treated with a phenothiazine. Preliminary observations led us to consider the role of these drugs in protein synthesis, with specific interest in the gamma globulin, since antibodies are associated almost exclusively with this fraction. Further interest in the problem of protein synthesis was stimulated by the reduced albumin and increased globulin levels found in most chronic psychoses, as the phrenotropic drugs are capable of significantly shifting this ratio toward normal. The question of phrenotropic drug action on antibody synthesis was asked at the Second International Congress of Psychiatry in September, 1957, and no specific information was known to the participants (Saunders, 1958). With this background, the question warranted further study in man. We designed our experiment to measure antibody response to oral poliovirus vaccine, Cox strains types 1 and 3, during phenothiazine therapy.

A preliminary study (Robin et al., 1961) of twenty out-patients showed nealbarbitone to be a therapeutically useful drug. The following study was undertaken to validate this trial.

How useful to the psychiatrist are subjective complaints by a patient?

The question of objective appraisal was reviewed by Harris (1938, 1954) in connection with follow-up studies, initially of in-patients, and latterly of day-patients, at the Maudsley Hospital.

The clinical manifestations that may result from abuse of alcohol are numerous. Profound, sometimes fatal, hypoglycaemia, first described a little over 20 years ago (Brown and Harvey, 1941), is among them although as far as we are aware, not previously described in this country. This may be due partly to differences in drinking habits here and abroad where “bootleg” liquor is more readily available, and partly to failure to recognize this complication of alcohol. Many cases of alcohol induced hypoglycaemia may well go undiagnosed, alcoholaemia alone being held responsible for bizarre behaviour or alteration in consciousness following the drinking of alcohol-containing beverages. In some cases, a patient brought into the casualty department with a provisional diagnosis of “drunkenness” is found to have a low blood sugar and the diagnosis hastily altered to the more socially acceptable one of “hypoglycaemia”, but without the cause of the hypoglycaemia ever being determined.

The most pressing problem in general practice today is the provision of adequate psychotherapy for psychogenic illness, which is responsible for 30 per cent. of all consultations (College of General Practitioners, 1958) and only a small proportion of which can be treated by trained psychiatrists. This paper describes a form of brief psychotherapy directed towards modifying neurotic character traits and securing freer expression of personality assets in the passive compliant type of personality which was found in 71 per cent. of all patients specially interviewed in late 1959 and 1960 in a working-class Belfast practice.

Hamilton and Salmon (1962) and Hamilton (1964) have investigated the effect upon male chronic schizophrenics, inter alios, of the following regimes: (a) working in a hospital industrial workshop, (b) occupational therapy and (c) no specific activity (the first study only). Hamilton (1964), considering both studies, concludes that the results “may be said to weight the available evidence in favour of the superiority of Workshop Therapy”. Certain points should be raised in connection with this conclusion.

In our unit open heart surgery has provided sufficient stress to precipitate post-operative psychological disturbances in a high proportion of patients. In the year before this investigation was begun, 21 of 108 patients developed obvious mental abnormalities post-operatively. Blickenstorfer (1) reported post-operative psychosis in 3 per cent, of 300 patients subjected to open heart surgery, and the same incidence, 3 per cent., was reported by Bolton and Bailey (3) following closed and open heart surgery on 1,500 adult patients. The incidence of mental disturbance in our unit was so much higher that a detailed study of all patients (141) operated on in the unit during a 10-month period appeared to be indicated.

Many authors have observed a decrease in glucose-tolerance (G.T.) in melancholia (sec reviews by McFarland and Goldstein, 1939; Altschule, 1953). Using an intravenous test, the present author confirmed that G.T., and also body weight, were significantly lower in a group of depressions than in a matched control group (Pryce, 1958a), but that within the depressions G.T. was not related to body weight. In a subsequent study also (Pryce, 1958b) change in G.T. after treatment was not related to change in body weight nor to three measures of change in emotional state. These studies, therefore, failed to support the views that the decreased G.T. in depressions is related either to nutritional or to emotional factors.